21 May 2009
The use of high dose human immunoglobulin in highly sensitized patients on the kidney transplant waiting list – one center experience
J Gozdowska, A Urbanowicz, K Michalska, A Chmura, J Szmidt, M DurlikAnn Transplant 2009; 14(1): 25-25 :: ID: 880290
Abstract
Background: Waiting time for kidney for patients (pts) with high anti-HLA titters is much longer because of the additional immunologic barrier, substantial risk of rejection and early graft loss. Intravenous infusion of pooled human immunoglobulin (IVIG) is immunomodulatory, neutralizes circulating Ab, reduces AR - all improve long-term outcome of Tx.
Material/Methods: 10 adult ESRD pts listed for kidney Tx, aged 29-52, highly sensitized to HLA (historical PRA >80% and current 56-100%) were selected for high dose IVIG (1 g/kg monthly for 4 Mo). Mean waiting time on the list was 7.5 y. Anti-HLA titters were monitored monthly by CDC before each and after last IVIG. Upon completion pts were put on urgent list and monitored as to Tx, incl. renal function and AR episodes.
Results: 9 pts completed the study. 1 pt was transplanted after 1st IVIG, and
remaining pts (N=8) received all 4 doses. PRA did not change in 3 pts, in 5 pts was reduced by 8-28% (mean 14.4%). During 6 Mo follow-up 4 pts were considered for Tx (neg. cross-match), 3 received Tx (1 disqualified - infection). Recipients received induction (ATG N=2; basiliximab N=2) and tacrolimus mycophenolate steroids as baseline immunosuppression. Protocol biopsies (1, 3, 6 Mo) were performed in 3 pts (1 denied a consent). On biopsy: 1 pt - AR free, 1 pt - vascular AR II B acc. to Banff '05 (treat.: steroids, ATG, IVIG), 1 - humoral AR with thrombotic microangiopathy (treat.: steroids, IVIG). Mean creatinine was 1.5 mg/dL 1 year after Tx (range 1.0-1.9).
Conclusions: 1. High dose human IVIG poorly reduces PRA in pts awaiting renal transplant. 2. It is advisory to perform protocol biopsies in highly sensitized recipients because of frequent AR incl. antibody mediated. 3. Shortterm outcome of transplantation is promising.
Keywords: Immunosuppression, Kidney Transplantation
131 0
In Press
02 Jun 2023 : Original article
Survival analysis of transplant-associated thrombotic microangiopathy under different diagnostic criteria a...Ann Transplant In Press; DOI: 10.12659/AOT.939890
17 May 2023 : Original article
Results of Liver Retransplantation After Rescue Hepatectomy: A Single-Center StudyAnn Transplant In Press; DOI: 10.12659/AOT.939557
10 May 2023 : Original article
Incidence of Thromboembolic Complications Following Kidney Transplantation with Short and Extended Aspirin ...Ann Transplant In Press; DOI: 10.12659/AOT.939143
Most Viewed Current Articles
24 Aug 2021 : Review article
Normothermic Machine Perfusion (NMP) of the Liver – Current Status and Future PerspectivesDOI :10.12659/AOT.931664
Ann Transplant 2021; 26:e931664
26 Jan 2022 : Review article
Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive ModelsDOI :10.12659/AOT.934924
Ann Transplant 2022; 27:e934924
29 Dec 2021 : Original article
Efficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...DOI :10.12659/AOT.933588
Ann Transplant 2021; 26:e933588
15 Mar 2022 : Case report
Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...DOI :10.12659/AOT.935860
Ann Transplant 2022; 27:e935860